When I was first writing about preventing burnout, I did not feel that I could add much personal value.
I bypassed the prevention stage completely. I headed straight to having to think about recovering from burnout.
If I had recognised where my escalating stress would have led me, if I had appreciated how unwell I would become as a result, and what effects it would have on my family and work, I would certainly have taken more effective action sooner.
So what stopped me?
I did recognise that I was extremely stressed and anxious. I think that was clear to everyone else around me too.
There are barriers generic to all doctors in seeking help.
For me my main concerns were, and still are to some extent:
- Judgement of Others. Overwhelmed by guilt, shame and a sense of failure, I feared what my colleagues, peer group, friends, family and my own GP would think of me.
- Confidentiality. Practice staff at my registered practice knowing my work colleagues professionally and socially.
- Future implications. What effect could the diagnosis of anxiety in my medical records have long term for my career? Would a potential employer take on someone ‘fragile’ in such a tough current NHS environment?
How could I have overcome those barriers earlier?
Seeking help and knowing that it is time to stop
If I had known now how supportive and non-judgemental everyone would be, I would have sought help much earlier.
I would have had the courage to stop work earlier, without getting unwell so that I had to take time off sick. This would have impacted far less on my work colleagues who then had to take up the slack.
I didn’t want to let anyone down or give up, but in persisting, I made things worse and risked creating more work for everyone else.
So what would I do differently?
There are five main things that come to mind.
They are simple and obvious, but they were not clear to me at the time.
1) Improved self-awareness
I was aware of the negative impact of my stress on myself. I was living and breathing it for months. I was absorbed in it. Consumed by it.
I didn’t truly appreciate however the impact it had on everyone else. An example.
I suddenly got worried about a blood sugar level result of a patient over the Christmas break. Out of the blue, from nowhere came this thought. On Christmas Day evening, I didn’t sleep. It felt imperative to access the records to check. Perhaps this patient would develop HONK over the four day break? I left my Mum’s and drove an hour to the practice but brought the wrong keys. My husband drove an hour to bring the right ones to me. The kids were left with my mum whilst she was trying to prepare for hosting Boxing Day for 30 people.
I checked the results. The patient was fine. Tick, my anxiety was gone. I knew that this was out of control, but I had relief from that awful feeling in my stomach.
Through CBT, I started to appreciate the negative impact of my anxiety on my family and my work. It was a real awakening. Chronic stress and the crippling anxiety it fuelled in me was not worth it, and is not worth it.
I have now made changes in my life to manage stress better. Setting time aside for myself and practising mindfulness (though not for everyone) have really helped.
2) Improved energy balance
I discuss the burnout matrix and it’s different aspects in more detail here.
I have found this incredibly helpful, particularly in considering strategies going forwards that might reduce stress at work and home, whilst also considering ways to recharge more effectively at both.
3) Being proactive
Having systems in place at home and at work to enable both to run smoother and more efficiently so that you are in a proactive position wherever possible. Being constantly reactive is known to predispose to burnout and stress. This links in with the burnout prevention matrix above. I am working hard now to get those systems in place.
4) Be compassionate
We all strive to be compassionate to our patients. After all, for most of us working clinically, this is the most important and rewarding part of our job. The real sense of making an immediate positive impact on people’s lives. Listening to their stories, making diagnoses and sifting through the content to pick out what matters. Taking on board patients’ worries, their pain, their joy, and their hope.
I don’t think that I have ever lacked this or lost this.
But somewhere for me, I lost compassion for myself, and in talking to other doctors, I know that I am not alone in this.
I also found that because I was so completely absorbed in my own downward spiralling anxiety that I had no energy or headspace to help those around me.
It strikes me that for many of us working that we often lose that compassion for others – for our families, our friends and our work colleagues. And to survive going forwards, we need to support one another and be present and mindful. We need to appreciate that no one is superhuman. We need to recognise that being vulnerable is courageous and that there is no shame in putting our hands up when we need help.
5) Have courage
Having the courage and confidence to ask for help.
To say no, to say that the workload is unrealistic, that it is too much. To say that I am struggling with it.
Having the courage to set clear boundaries and not worry about what others think.
Having the courage to recognise when things are too much. Having the courage to stop.
It has taken me a while to share this post because it has felt very personal.
I felt embarrassed and ashamed to not to have had the ability to recognise how unwell I became until it was too late. However, I recognise that I have a choice going forward, and that choice is to use this positively and learn from it.
I am sharing this now, with the hope that it might be helpful to others out there who are also struggling. And to reassure you if you are, that you are not alone.